Implementing Change in the Cardiac Operating Rooms

Change is occurring rapidly throughout healthcare. The effects of these changes are felt at the global, national, state, and organizational level. At a large, Midwest teaching institution, there are many initiatives that must be implemented throughout the organization quickly. In this organization, eight cardiac operating rooms are constantly experiencing change. Successful implementation of changes in policies, procedures, and practice is essential to providing the best possible care for the patients in cardiac surgery. The purpose of this system change project was to increase staff involvement in the change process by discussing barriers to implementation, and allowing cardiac surgery staff to successfully implement, embed and sustain change within a system. The staff included the registered nurses, certified surgical technologists, and certified surgical assistants that work in the cardiac operating rooms. The project utilized action research and a quality improvement framework using mixed methods. It involved two phases. Phase I was a qualitative design used to gain an understanding of the perceptions of registered nurses, certified surgical technologists, and certified surgical assistants in the cardiac operating rooms about the current process for communicating and implementing changes in policies, procedures, and practice. Phase II involved implementing the solutions identified by the cardiac surgery staff and evaluating the outcomes. The three solutions implemented were (a) to provide staff information on changes before they will be implemented, (b) to utilize electronic resources for surgeon preferences, and (c) to implement a communication board in the cardiac office. Only the effectiveness of the process for updating surgeon preferences (x 2 = 18.83; p=.001) was found to be statistically significant. Although not statistically significant, there were positive trends for all of the solutions. Understanding how the process for communicating and implementing changes affect staff can help guide future initiatives. Integrating individuals in the process of change from the beginning provides the opportunity for staff engagement. When staff feel they have ownership of the process, successful adoption of change is likely to follow. This systems change project has laid the groundwork for future work in change implementation, and provided an opportunity for future improvements in the cardiac operating rooms. Additional research is needed to understand what creates resistance in groups. Also, more information is needed on how change processes should occur. It will be essential to continue work related to change implementation to build the knowledge base as to what works best for the organization, so the best care is provided to patients

Establishing environmental variability in the toxins produced by a single strain of prymnesium parvum

Prymnesium parvum (P. parvum) is a toxin producing haptophyte that has spread globally over the past 100 years. The algae, initially a marine organism, has moved inland to less saline waters. In addition, there is variability in the efficacy of the toxins produced from bloom to bloom. Variation between strains has been suggested as the reason for bloom differences; however, environmental variability within a single strain must first be established. Here, a single strain of P. parvum was cultured at three environmentally relevant salinities, 6psu, 13psu, and 35psu. Three different environmental shocks, decreased temperature, raised pH, and addition of specific ions were applied to cultures of alga at each of the three salinities. Supernatant from each condition was used to test variability in hemolytic, cytolytic, and ichthyiotoxic properties. Culture salinity influenced growth rate of the algae, with increased growth rates at higher, marine salinities. Ichthyotoxicity of toxins produced were also increased with increased culture salinity. Cytolytic and hemolytic properties were found to vary with culture salinity; however, these properties were greatest at a culture salinity of 13psu. Environmental shocks also caused significant variability in efficacy of toxins produced. These tests demonstrate variability in toxic effect within a single strain of P. parvum and provide insight into the wide array of toxic effect in blooms worldwide

Body Image and Quality of Life Among Postsurgical Bariatric Patients

In recent decades, bariatric surgery has become an increasingly popular intervention for the treatment of morbid obesity. Bariatric surgery leads to substantial improvements in physical health (e.g., weight loss, increased life expectancy) and psychological health (e.g., body image, quality of life). After bariatric surgery, many patients undergo subsequent surgical procedures to remove excess skin (“body contouring”), which are also associated with positive medical and psychological outcomes. The present study sought to expand upon existing research into the psychosocial outcomes of bariatric surgery, investigate correlates of patients’ desire for body contouring, and determine whether presurgical motivations were associated with postsurgical outcomes. Seventy-nine adult postoperative bariatric patients completed a computer-based survey containing measures of body image (Multidimensional Body-Self Relations Questionnaire [MBSRQ]), quality of life (Impact of Weight on Quality of Life Questionnaire-Lite [IWQOL-Lite]), body image quality of life (Body Image Quality of Life Inventory [BIQLI]), desire for body contouring surgery, and presurgical motivations. A hierarchical multiple regression found that weight loss was associated with improvements in body image and quality of life – but not body image quality of life. Although most patients reported dissatisfaction with their abdominal region after surgery, a linear regression failed to identify a relationship between patients’ body dissatisfaction and their desire for body contouring surgery. However, a paired-samples t-test found that patients were significantly more likely to express an interest in body contouring surgery if finances were not a factor, suggesting that the cost of these procedures may be prohibitive to many. Finally, content coding of patients’ self-reported motivations found that health-related reasons were the most commonly cited reason for pursuing bariatric surgery, identified by more than half of participants. Despite predictions, an independent samples t-test found that patients who identified appearance-related reasons for pursuing bariatric surgery did not differ on measures of body image. Subsequent independent samples t-tests failed to identify any association between presurgical motivations and postsurgical weight loss. Although limitations of this study included its small sample size and single-site methodology, its results serve to validate existing research while expanding upon the understudied topics of body contouring and presurgical motivations

Supporting the Development of Racial Identity and Cultural Humility in Higher Education

This banded dissertation consists of three sections which provide a social work perspective on the impact of microaggressions on racial identity for students of color (SOC) in a predominantly white institution (PWI). The dissertation suggests a developmental paradigm for social work educators to increase student understanding of systemic racial oppression and support for the development of cultural humility. Critical race theory provides a framework to analyze inequities in higher education and a guide to the creation of inclusive learning environments. Effective engagement in diversity assumes students understand the role of privilege and marginalization and how each contributes to one’s life experiences. The first section of the banded dissertation is a conceptual paper that integrates concepts derived from Critical Race Theory and provides a developmental paradigm for social work educators to teach and support anti-racist social work practice. Critical Race Theory also provides the framework for second section of the banded dissertation, an exploratory, qualitative study. Study participants included thirty-one, SOC who attended a mid-sized, Midwestern, faith-based, PWI for at least one year. Respondents completed individual or focus group interviews which explored the impact of racial stress on student development, adaptive responses, and what recommendations SOC have for greater inclusiveness in spiritual life within the institution. The third section of the banded dissertation is an overview of a peer-reviewed workshop. This workshop introduced a conceptual framework to engage professional social work educators in conversation and collaboration regarding teaching issues of race, privilege, and oppression. This workshop integrated concepts from Critical Race Theory and will assisted in further development of an anti-racist, developmental model for social work educators. The data from this banded dissertation are consistent with studies on campus climate as well studies on the impact on racial microaggressions on SOC in higher education. However, this banded dissertation adds to the existing literature through examination of the impact of racial stress on spiritual development; evaluation of how experiences with racism have contributed to adaptive responses; and, recommendations from study participants as to how the institution can better support spiritual development and greater inclusiveness for SOC

A meta-analysis of service learning research in middle and high schools

This study examines the relationship between service learning innovations and improved academics, self-concept, and social or personal growth in middle and high school students. Meta-Analysis is employed to arrive at effect-size estimates for each construct. A historical overview of service learning is presented and a detailed description of the study selection process is provided. The data revealed a moderate relationship between service learning participation and academics, self-concept and social or personal growth in middle and high school students. The findings are presented, and some appropriate conclusions are drawn. A discussion of the implications of these findings and recommendations for future research are also provided

A meta-analysis of service learning research in middle and high schools

This study examines the relationship between service learning innovations and improved academics, self-concept, and social or personal growth in middle and high school students. Meta-Analysis is employed to arrive at effect-size estimates for each construct. A historical overview of service learning is presented and a detailed description of the study selection process is provided. The data revealed a moderate relationship between service learning participation and academics, self-concept and social or personal growth in middle and high school students. The findings are presented, and some appropriate conclusions are drawn. A discussion of the implications of these findings and recommendations for future research are also provided

Reframing the Subject: Abjection in Twentieth-Century American Literature

In response to major societal change in the early years of the twentieth century, modern psychology suggested new ways of thinking about selfhood. One’s relationship with oneself, one’s subjectivity, came to be viewed as being processed through a matrix of factors that the self is subject to. The notion of the Cartesian “self” was thus seriously questioned. Is there an essential self? To what extent is self conditioned by environment? Can we know ourselves? If not, is the self worth talking about

Supporting the Development of Racial Identity and Cultural Humility in Higher Education

This banded dissertation consists of three sections which provide a social work perspective on the impact of microaggressions on racial identity for students of color (SOC) in a predominantly white institution (PWI). The dissertation suggests a developmental paradigm for social work educators to increase student understanding of systemic racial oppression and support for the development of cultural humility. Critical race theory provides a framework to analyze inequities in higher education and a guide to the creation of inclusive learning environments. Effective engagement in diversity assumes students understand the role of privilege and marginalization and how each contributes to one’s life experiences. The first section of the banded dissertation is a conceptual paper that integrates concepts derived from Critical Race Theory and provides a developmental paradigm for social work educators to teach and support anti-racist social work practice. Critical Race Theory also provides the framework for second section of the banded dissertation, an exploratory, qualitative study. Study participants included thirty-one, SOC who attended a mid-sized, Midwestern, faith-based, PWI for at least one year. Respondents completed individual or focus group interviews which explored the impact of racial stress on student development, adaptive responses, and what recommendations SOC have for greater inclusiveness in spiritual life within the institution. The third section of the banded dissertation is an overview of a peer-reviewed workshop. This workshop introduced a conceptual framework to engage professional social work educators in conversation and collaboration regarding teaching issues of race, privilege, and oppression. This workshop integrated concepts from Critical Race Theory and will assisted in further development of an anti-racist, developmental model for social work educators. The data from this banded dissertation are consistent with studies on campus climate as well studies on the impact on racial microaggressions on SOC in higher education. However, this banded dissertation adds to the existing literature through examination of the impact of racial stress on spiritual development; evaluation of how experiences with racism have contributed to adaptive responses; and, recommendations from study participants as to how the institution can better support spiritual development and greater inclusiveness for SOC